Provider Demographics
NPI:1578838520
Name:PACIFIC COAST MEDICAL CENTER INCORPORATED A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC COAST MEDICAL CENTER INCORPORATED A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIHOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-464-7738
Mailing Address - Street 1:2351 W MARCH LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5292
Mailing Address - Country:US
Mailing Address - Phone:209-464-7738
Mailing Address - Fax:209-464-5142
Practice Address - Street 1:2351 W MARCH LN
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5292
Practice Address - Country:US
Practice Address - Phone:209-464-7738
Practice Address - Fax:209-464-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73756305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service